Is Addiction Treatment Covered by Medicare?

Medicare is a government-funded insurance program, easing the burden of healthcare costs for people aged 65 and older, some individuals with disabilities, and those with end-stage renal disease. The program is divided up into different parts, which are designated to provide coverage for different services. These parts include:

Medicare Part A: This includes hospital stays, skilled nursing facility stays, hospice, and some forms of home healthcare.

Medicare Part B: This includes general doctors’ visits, outpatient treatment, medical supplies, and preventative treatments.

Medicare Part C: This is available through a private company that contracts with the government program. Included in Part C are Parts A and B, along with copay plans, special needs coverage, and medical savings plans.

Medicare Part D: Prescription medications are covered through insurance companies, including private insurance, which contract with the government to reduce costs.

None of these parts specifically state that substance abuse treatment is covered. With the passage of the Affordable Care Act (ACA), insurance programs are required to cover mental and behavioral health services, including substance abuse. Medicare does cover several aspects of substance abuse treatment, although the process may not be streamlined from detox to rehabilitation to aftercare, as it is with other insurance programs.

How Medicare Covers Substance Abuse Treatment

Alcohol misuse: People with Part B can get four face-to-face counseling sessions regarding alcohol use disorder and problem drinking, provided by a counselor or primary care physician in the provider’s office. The individual’s primary care doctor must diagnose the patient with alcohol misuse, and then refer the person to treatment, to receive this coverage.

Outpatient hospital services: This includes emergency treatment, overnight stays, observation, laboratory tests, preventative care, some medications, and mental health treatment through partial hospitalization. Through Part B, the individual covers 20 percent of the total cost, with some copays for other services.

Inpatient and outpatient mental health treatment: Part A partially covers mental health treatment in a hospital setting; however, only 190 days are covered for the individual’s lifetime. Those using inpatient treatment must pay a $1,316 deductible for the benefit period; the first 60 days are completely covered, then days 61-90 involve a $329 coinsurance payment per day, and after day 91, the coinsurance payment is $658 per day. There may be other payments for inpatient treatment, too.Outpatient mental health treatment is covered by Part B, with some copayments and coinsurance amounts determined based on how frequently the individual requires treatment or if the individual must be hospitalized. Depression screenings are free, and counseling sessions are mostly covered. Treating mental health conditions can reduce the risk of substance abuse struggles, especially among older adults.

Medication-assisted treatment (MAT): Drugs used to treat opioid addiction, like buprenorphine, may be covered by Part D, which eases the financial burden of prescription medications. Access to MAT may depend on whether the medication is administered by a Medicare-certified program; if it is not, it may not be covered.

Clinicians Who Can Treat Addiction

There are several specialists covered by Medicare who may be able to diagnose, refer, or treat those struggling with substance use disorders. These professionals include:

Physicians

Physician assistants

Clinical psychologists

Social workers

Nurse practitioners

Nurse specialists

Certified nurse-midwives

Having access to medical professionals who recognize the symptoms of substance abuse, like high blood pressure, liver problems, and behavioral changes can help older adults, especially when they have struggled with chronic substance abuse for several years. Additionally, access to mental health treatment helps to reduce the risk of substance abuse co-occurring with mental illness.

Treatment Access Is Important for Older Adults

Although many surveys focus on the substance abuse struggles of adolescents and young adults, older adults often struggle with substance abuse. People ages 65 and older struggle with alcohol, opioids, and illicit drugs – not in the same ways as young adults, but at significant enough rates to warrant medical coverage to help them overcome addiction.

For example, older adults predominantly struggle with problem drinking, especially heavy drinking – defined as more than two drinks per day, most days of the week. This persistent pattern of drinking damages internal organs and can lead to long-term health problems. Alcohol also interacts badly with most medications, and as people age, they are more likely to receive prescriptions to treat chronic issues like high blood pressure, diabetes, osteoarthritis, and mental health conditions.

Exposure to potent prescription drugs like opioids and benzodiazepines puts older adults at risk for developing addictions to these substances. If the individual struggles with chronic pain, their doctor may be more willing to prescribe drugs to treat the pain but monitor the individual’s behaviors less. This puts the older adult at great risk for addiction, dependence, and overdose.

Finding Addiction Treatment in Rhode Island That Accepts Medicare

As the large baby boomer generation ages, finding integrated substance abuse treatment covered by Medicare is increasingly important. Many detox and rehabilitation facilities provide these services, partially covered by Medicare. A few Rhode Island treatment programs that accept Medicare include: